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Big Pharma bad? Here are some facts about the “alternative”

With their money, myopia and abuses, these pill makers match big pharma

The food supplement industry likes to style itself as people’s medicine, but the way it stifles debate is far from democratic

Ben Goldacreguardian.co.uk,Friday September 12 2008 19:00 BSTMatthias Rath today pulled out of a legal case against the Guardian which has cost the organisation £500,000 to defend. I am proud that we fought it. Rath is an example of the worst excesses of the alternative therapy industry; UK nutritionists make foolish claims on poor evidence – they can make your child a genius with fish oils, or prevent heart attacks in the distant future – but Rath transplanted these practices into the world of HIV/Aids, where evidence really matters.

The potential consequences of his actions are outrageous, but he is by no means untypical. This sector has engineered a beneficent public image for itself, a warm and friendly cottage industry; but that fantasy is not borne out by the facts.

First, despite claims about the true evils of “big pharma”, presented as if they were evidence that vitamin pills are effective, there is little difference between the vitamin and pharmaceutical industries. Key players in both include multinationals such as Roche and Aventis; BioCare, the vitamin pill producer that media nutritionist Patrick Holford works for, is part-owned by Elder Pharmaceuticals, and so on.

The food supplement market, comprising products like vitamin pills and herbal supplements, is worth $50bn worldwide (against $600bn for pharmaceuticals). It has lobbied angrily and successfully against safety regulation, and the vitamin industry is also legendary in the world of economics as the setting of the most outrageous price-fixing cartel ever documented: during the 1990s the main offenders pleaded guilty and had to pay $1.5bn, the largest criminal fine levied in legal history.

That’s quite some cottage industry, and it is tightly linked to the “nutritional therapists” community. Bant, their UK membership organisation, recently changed its code of conduct in accordance with the wishes of pill manufacturers, so that members can now take undisclosed financial kickbacks for the pills they prescribe to patients. Doctors are struck off the GMC register for this activity, and rightly so.

Last year I went to a public meeting hosted by Matthias Rath in east London. He spoke for three gruelling hours, and every time he mentioned the side-effects of a treatment prescribed by doctors, the people in the seats behind me growled the word “murderers” in a venomous tone. Their hatred was intense, and it was unnerving to sit near them.

How do people become so extreme in their views? How have they been isolated from the realities of the miracle cure industries? A combination of wishful thinking, successful PR, and legal muscle.

When I attempted simply to write that the Dore miracle cure for dyslexia had not cured three people, we received several legal warning letters, delaying the piece by a month. An academic who dared to criticise the evidence base for the programme received a threatening legal letter delivered by hand to her home address.

Gillian McKeith has made repeated legal threats against websites who have dared to discuss her work, and her lawyer husband has threatened an academic who suggested testing her ideas. She also has a legal case hanging over the Sun that has seen little movement in three years.

When chiropractors had their practices challenged in the New Zealand Medical Journal they simply sent a threatening legal letter (“Let’s hear your evidence,” said the editorial in response, “not your legal muscle”). A herbal pill entrepreneur – and academic – had Professor David Colquhoun’s website removed from UCL servers after he dared to question her evidence. The Society of Homeopaths had a blogger silenced by threatening his web host.

I could go on. And of course, deterring dissent goes wider than the use of libel law. There is also the bizarre smear operation against critics of the food supplement industry, and an elaborate campaign conducted by homeopaths against Professor Edzard Ernst, an academic who has simply dared to examine the evidence for their claims, which ended up with his employers at Exeter University being harassed to silence him.

Meanwhile the alternative therapists who run university BSc courses refuse to release their lecture notes, or let anyone see their exam papers, in a desperate attempt not to engage with critical appraisal from the worlds of scientific evidence of which they purport to be a part.

This is not just unpleasant, it is also unhealthy. Ideas improve when they are challenged and questioned. I am a doctor, journalist and academic. I criticise the activities of doctors, journalists and academics in each of my jobs, and I welcome other people criticising my ideas.

Nothing could be more anti-democratic or stifling to debate than using money, law and power to regulate what can be discussed, and yet those who do it have the gall to represent themselves as the outsider, the little man, concerned with the medicine of the people. In reality they behave like nothing more than commercial entities.

The food supplement pill industry is phenomenally powerful, extremely lucrative and incredibly influential, but it has shown itself to be philosophically and commercially incapable of critical self-appraisal. Rath is its product. It is inconceivable that any individual within th
at industry would be brave enough to stand up and criticise his activities – and for that, more than anything else, it should be condemned.

Ben Goldacre, a medical doctor and author of the book Bad Science, writes the Bad Science column in the Guardianbad.science@guardian.co.uk